Patients who do not have insurance or who are not using insurance may expect the following  estimate of charges for psychotherapy services:

Diagnostic assessment (90791): $160.00

55 minute psychotherapy appointment (90837): $150.00

75 minute couples therapy: $180.00

An estimate of total charges will be given for out of network and uninsured clients.

Please be sure to cancel appointments within 48 hours. Late cancellations or no-shows may be billed at  a rate of $50.

I participate directly on the panels of Blue Cross/Blue Sheild, Medicare, Aetna, and United Behavioral Health (Optum).

24-hour notice is requested for changing or cancelling appointments.

The office accepts cash, checks, Venmo and credit cards.

Services are provided either in person at 1020 Southhill Dr., Suite 350 in Cary, or through a secure tele-health portal.

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.

You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.

Eye Movement Desensitization and Reprocessing is a comprehensive protocol that was was first developed in 1987 by Francine Shapiro, Ph.D. as a rapid and effective way of treating trauma or overwhelming life events. EMDR has been widely studied worldwide, and is currently recognized as evidence based and a first line treatment by the Department of Defense and the American Psychiatric Association for treating trauma. While originally used for treating military combat or life threatening assaults or events, the protocol has since been broadened to include less severe, more chronic types of negative events, such as long term neglect, chronic shaming situations, lack of support, developmental trauma etc., Those life events tend to set the stage for lingering symptoms such as anxiety, depression, dissociation etc. later in life. EMDR often relieves those symptoms and opens the door to new, more adaptive ways of thinking, behaving and feeling.

The eight step EMDR protocol involves assessment, education, focused attention to the distressing event, bi-lateral stimulation, and future templating of a preferred feeling/reaction to the previously triggering stimulus. Bilateral stimulation may be in the form of eye movements or hand held vibrations, and are used while simultaneously attending to an image of the distressing event, along with the associated thoughts, feelings and bodily sensations. During the processing phase of the protocol, clients typically report increased feelings of calm, a change in perspective, a fading of the negative emotions and images associated with the past event, new positive associations, increased feelings of mastery over the distressing event, and a strengthening of one’s ability to implement new skills in future situations.

EMDR may be used on it’s own in healthy individuals with a single incident trauma, or it may be integrated into a more comprehensive course of psychotherapy for those with more complex issues. The use of meditative techniques and guided imagery are often integrated into the EMDR protocol for deeper healing and for generalizing the therapeutic effects of EMDR.

The client/therapist relationship and documentation related to such is protected by the Health Information Portability and Accountability Act (HIPAA). This means that a confidential health record, including psychotherapy notes, will be created and maintained by my office. This will have identifying information about you – herein referred to as PHI- Protected Health Information. I am required by law to maintain the privacy of PHI and to provide you with notice of my legal duties and privacy practices with respect to PHI. I am required to abide by the terms of this Notice of Privacy Practices. If there is a change in this law I will update this website to reflect those changes.

• For treatment – With your permission, your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with other treating or involved persons, such as a psychiatrist, a physician, involved family members, a coordinating school counselor, etc.
• For Payment –  With your authorization, PHI will be disclosed for purposes of billing insurance companies for insurance reimbursement of services provided to you.  Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities.  If it becomes necessary to use collection processes due to lack of payment for services, I will disclose the minimum amount of PHI necessary for purposes of collection. If you pay for services using a credit card, the charge will be posted as  “V & E Guarnaccia.”
• For compliance in a court of law – In response to a court subpoena, court order, administrative order or similar process, I would be required to disclose your PHI, however I would disclose the minimum amount of information as necessary to fulfill my legal duty.
• Law enforcement – I may be required to disclose PHI to a law enforcement official as required by law, in compliance with a subpoena (with your written consent), court order, administrative order or similar document, for the purpose of identifying a suspect, material witness or missing person, in connection with the victim of a crime, in connection with a deceased person, in connection with the reporting of a crime in an emergency, or in connection with a crime on the premises.
• In cases of suspected child abuse or neglect, or elder abuse – I am required to file a report of any suspicions or direct evidence with the appropriate state agency which investigates allegations of abuse.
• In cases of a suspected threats to onesself – If I believe a client is in imminent danger of serious self-harm, due to verbalized intent, plan and/or actions consistent with such, I am required to report those suspitions to the police, crisis center, or other involved health care agency or professional who could/will intervene. Additionally I may disclose information to close family members or friends directly involved in your treatment based on your consent or as necessary to prevent serious harm.
• In cases of suspected threats to another person – If I believe a client to have intentions of harming another person, I am required to notify the intended victim if I am able, or to notify the police.

Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked at any time, except to the extent that I have already made a use or disclosure based upon your authorization.

• You have the following rights regarding PHI I maintain about you:
  • You have the right to access your record and to ask me questions about such. Your right to inspect and copy PHI will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you or if the information is contained in separately maintained private psychotherapy notes.
  • Right to Amend your record –  If you feel that the PHI is incorrect or incomplete, you may ask to amend the information although I am not required to agree to the amendment. If I deny your request for amendment, you have the right to file a statement of disagreement with me. I may prepare a rebuttal to your statement and will provide you with a copy.
  • Right to Request Restrictions.  You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations.  I am not required to agree to your request unless the request is to restrict disclosure of PHI to a health plan for purposes of carrying out payment or health care operations, and the PHI pertains to a health care item or service that you paid for out of pocket. In that case, I am required to honor your request for a restriction.
  • Breach Notification. If there is a breach of unsecured PHI concerning you, I may be required to notify you of this breach, including what happened and what you can do to protect yourself.
  • Right to a Copy of this Notice.  You have the right to a copy of this notice.

If you believe I have violated your privacy rights, you have the right to file a complaint in writing to me or to my licensing board, NCSWCLB: PO Box 1043, Asheboro, NC 27204  or by calling (336) 625-1679.  I will not retaliate against you for filing a complaint.